Three Diseases Fund

Established on 12 October 2006, the Three Diseases Fund (3DF) is a mechanism of international pooled funds to support a countrywide programme to reduce transmission, and enhance provision of treatment and care for Tuberculosis (TB), Malaria and HIV and AIDS for the most-in-need populations in Burma/Myanmar. Of the pledged US$100 million—fluctuation of the US dollar against other currencies theoretically increased this amount to US$106 million)—over five years from six donors, the Fund Manager (FM) received by the end of December 2007 contributions amounting total US$31 million.

Round I

Out of 67 Expressions of Interest (EOI) in Round I from 43 organizations, reviewed by a panel of independent experts, eventually 34 agreements were signed between the Fund Manager and 23 implementing partners from May 2007 onwards. In just over a year, the Fund has successfully developed and implemented policies and systems for effective fund management and programme implementation.

Round II

A Round II was launched in 2008 with a deadline for EOI on 01 June, aiming at strengthening accountable and inclusive local organizations with small grants. The Fund Manager has screened the EOI and will call short-listed organizations to further submit detailed proposals by September 2008. A panel of expert should review these proposals and made recommendations for Memoranda of Agreement with the Fund Manager to be approved by the Fund Board.

Coordination

At the institutional level, Technical and Strategic Groups and a Coordination Body of the national response have met to develop and approve National Strategies for the three diseases, and National Operational Plans. All related bodies were established and have made a good start in coordinating effectively.

Accountability and Transparency

The Fund has developed a number of policy documents and guidelines to address accountability and transparency. All these enforce the zero tolerance policy on all aspects of fraud and corruption adopted by the Donor Consortium, Fund Board and Fund Manager.

A risk management advisory group carefully considered risks on a monthly basis and updated a risk assessment matrix. External and internal risks to the Fund’s operating environment alongside implementation risks were routinely evaluated in Fund Board meetings and mitigation measures drawn upon.

Communication

Communication and public information initiatives included the development of this interactive web platform in October 2007 to make all 3DF key documents available to the public, the rolling out of the 3DF logo in every funded project, and the development of a number of public information materials in English and Burmese languages (posters, maps, compendium of key documents). A communication strategy was developed to outline communication activities and tools that promote a culture of transparency in all fund operations.

Monitoring and Evaluation

The National Programmes have independent monitoring and evaluation systems for each of the three diseases. Each system has the capacity to track activities and measure inputs, outputs, outcomes as well as impact of programme interventions at national level. The relevant departments of the Ministry of Health are responsible for routine monitoring of national responses to the three diseases.

The Fund Manager has not developed a parallel system to the existing one, but a framework that aims to monitor a number of crosscutting issues, the performance of its own activities and the activities of implementing partners based on disease-specific national core indicators.

HIV and AIDS Programme

It is estimated that the number of HIV cases could be around 230,000 adults (15 to 49 years) and 6000 children with 13,000 new infections per year and 75,000 adults and 1600 children in need of antiretroviral treatment. The 3DF is funding twenty agencies working with HIV and AIDS for a total amount of US$12,078,286 for one year, representing 60 percent of the funds for 2007-2008.

Using the current available estimate size of the population— whilst it is challenging to know the exact denominator for each group—the 3DF-supported HIV programme reached 13–25 percent of women selling sex, 3 percent of men buying sex, 26–36 percent of men having sex with men and 27–41 percent of men and women using drugs.

Implementing partners provided diagnosis, prophylaxis and treatment of opportunistic infections to 12,489 people living with HIV, and antiretroviral treatment with adherence counselling and monitoring for 10,104 patients.

Support for transport, food and accommodation was given to the HIV positive person and accompanying family members or project staff. Prevention of mother-to-child transmission was offered directly or through referral of pregnant women to public health facilities. Seven partner agencies out of twenty facilitated the establishment of self-help groups with technical or financial support.

There is a clear need to scale up the coverage for both prevention activities among people with high risk behaviour as well as access to services for people living with HIV and their families. The funds required to support the National Operational Plan are estimated to be around US$ 60 million. The 3DF has been perceived, and still is, by many HIV stakeholders as “the” national response rather than as a contribution to it. This perception has resulted in high expectations of the level of funding that should be provided.

TB Programme

Eight implementing partners were granted of total US$3,486,744 to contribute to the TB national response both geographically and programmatically. The 3DF-supported TB programme widely spread geographical coverage around the country, as well as reached a broad range of target groups apart from the general population, ethnic and marginalised groups, people living with HIV and AIDS, mobile population and health personnel.

With a 3DF grant WHO continued to build capacity in the National TB Programme (NTP) in all townships. A system of TB drug transportation system was secured for the whole country. Implementing partners strengthened DOTS supervision in Public Private Mix and community-based settings with capacity building of private GPs and community health volunteers. They contributed to improve case detection and treatment with support mechanisms to patients for referrals and nutritional supplements. HIV and TB integrated programmes were enhanced, as well general community awareness about TB.

A total of 13,863 new cases were detected, whilst 12,759 TB patients have been successfully treated and 14,645 suspected TB cases were referred to public health facilities. The PPM DOTS programme carried out in 107 townships by PSI and the Myanmar Medical Association (MMA) contributed to nearly 15 percent of the cases managed in the TB national response. The community-based DOTS programmes carried out by six partner agencies were limited to 22 townships to supplement the NTP efforts, in empowering communities in case detection and treatment through a network of community volunteers.

Currently the NTP supplies free anti-TB drugs in the country. An alarming challenge will be the free supply of anti-TB drugs, which are only secured until the end of 2009 from the Global Drug Facility. The Three Diseases Fund committed to fund the supply of second line TB drugs for the treatment of MDR-TB in an initial piloting phase for 100 patients. Currently the NTP supplies free anti-TB drugs in the country.

Malaria Programme

The Fund supported seven implementing partners in the area of Malaria control with total US$4,296,860. These partners offered a broad geographic coverage, reaching out remote communities through mobile and fixed clinics as well as supporting the national programme in delivering services to communities in the most endemic areas (137 townships out of total 325). Trained volunteers contributed to early detection and appropriate treatment of Malaria cases at community level.

Most projects provided free diagnosis and treatment, and commodities for prevention as well as transport costs for referrals to the vulnerable populations thus ensuring better access to services. As a result of all these activities, 31,000 Malaria cases were treated, 25,000 long lasting impregnated nets (LLIN) distributed and 43,000 bed nets treated with insecticide.

Procurement

The total value of medical commodities procured with 3DF grants over the first year of operation amounted US$4.5 million, of which the Fund Manager procured for US$510,000 of pharmaceuticals or medical supplies on behalf of organizations that did not have prior experience or capacity in international procurement. Antiretroviral drugs represented 41 percent, and general drugs used in the three diseases and to treat opportunistic infections 30 percent of the total amount.

Finance and Audit

Banking on the disbursement modalities established during the bridging period (October 2006 to August 2007), the Three Diseases Fund and WHO extended the implementation of the Fund Flow mechanism for another year with US$575,824. During the bridging period this direct disbursement modality for field activities by the public sector at township level had amounted to US$360,590.

As of 31 December 2007, the total available funds for the 3DF were US$31,848,368. The funds received from the donors were utilised for grants provided to implementing partners, the Fund Manager’s operational cost, support to Fund Board activities, research and other policy development activities. Balance carried forward was of US$8.8 million.

An external audit conducted in April 2008 reviewed the Fund Manager’s operations for 2007. The overall functioning of the Fund Manager was deemed satisfactory.